Posts Tagged ‘Public health’

SGH tragedy: “Penny wise, Safety foolish” allegation

In Public Administration on 04/11/2015 at 4:27 am

A regular reader and commenter who describes himself “As someone who has worked in PAP’s health system apparatus and also with the civil service real politicks” gives his take on the sharing of vials. (Btw, here’s his take on why Amos “the Fantastic” was sent to Block 7, Woodbridge.)

Btw, I hope he or she can explain where the huge losses occur in the system: bureaucracy, overstaffing?


The Hepatitis C outbreak in a Singapore hospital has cast the spotlight on a practice known as multi-dosing, where nurses or doctors inject patients by attaching new needles and syringes to a shared vial of fluid. 

The Singapore General Hospital – the site of the cluster – said the virus could have spread that way, and it has since stopped the practice. 

On Wednesday (Oct 7), the Ministry of Health said that it is “not yet conclusive” that the use of multi-dose vials is the cause of the Hepatitis C infections at SGH*.



Moral of the story is to have good medical insurance that can cover at least B1 or A-class in govt hospitals. Such “private class” patients are issued their own personal drug vials including multi-use ones — no such thing as sharing of multi-use vials.

The main reason is that C & B2 class are loss-making [CI note: Can explain how the losses come about?], requiring large injections of cash from MOH to cover. Much of the practices in C & B2 wards in govt hospitals e.g. standardised care plans, clinical pathways (equivalent to SOPs & IAs in army) are designed to save money & avoid so-called unnecessary tests / investigations / procedures.

Do you know that even “poor” community hospitals (e.g. Ren Ci, St Luke’s) issue personal multi-use drug vials to their patients — no sharing?!? How come?? Becoz these are considered as private hospitals & they are required by MOH to practice cost-recovery at a minimum, in order to obtain the minimal subsidies from ministry. Hence such hospitals simply issue personal drug vials as (1) to avoid cross-infections which will be hell to recover from as a “poor” community hospital with no ministry backing, and (2) vast majority of such drug vials are priced / cost in the cents or at most $1 or $2 — still easily recovered from individual patients.


*More from From CNA on 7 October

“Both single-dose and multi-dose injection medication vials are used in our public hospitals. Our public hospitals utilise multi-dose vials where the preparation is specifically formulated for such use, and governed by safety protocols,” MOH said in response to media queries.

“Regardless of whether medication vials are single-dose or multi-dose, their safe use requires healthcare providers to adhere to existing safety protocols for the use of medication vials. Staff education, appropriate training and compliance to the protocols are important in ensuring patient safety.

“As multi-dose vials are potentially at risk of contamination between uses, their safe use requires additional safety and infection prevention and control measures that staff have to comply with, such as opening only one vial of a particular medication at a time in each patient-care area, as recommended by WHO. Failure to comply to safety protocols may cause infection,” the ministry said.

MoH: PM needs a minister who can communicate

In Public Administration on 28/10/2015 at 4:36 am

PM says the PAP must change. Obviously MoH thinks otherwise. Is the MoH (minister included) saboing the efforts of the PAP administration to project a PAP administration that does the right thing in the right way, always explaining its actions.

Seriously like in transport where the PM said the minister in charge must be able to communicate to the public, MOH needs a minister who can communicate to ,we, the rabble.

When the “noise” whacked the MoH on the Heptais C tragedy, my sympathies were with the MoH. It was trying to fix a problem while dealing with the noise from the usual suspects like parachutist extraordinaire Goh Meng Seng (three GEs, three GRC and three different parties: and getting less votes eeach time). “Stuff happens. So why the chattering? 30% ng kum guan isit? So KPKB?”

Even when MoH responded in an ultra defensive, aggressive way to an ST article, I wasn’t too fussed. ST was a juz being a pariah trying to bite the hand that fed it. I was thinking, “Yup beating up ST is good. Dogs should not bite the hand that feeds them.”

But MoH’s response to WP’s call* for a Committee of Inquiry (COI) was so petulant, aggressive, defensive and so misrepresentative of what the WP said** that I’m wondering if there is an email or two somewhere in the system that could be perceived as a “smoking gun” that MoH wants to hide?

Seriously MOH needs to stop playing word games and being so ultra-defensive yet so aggressive.

As a member of the conservative FB group I belong to put it

I think that the final question that needs to be asked is:

“Why not?”

1) Does a COI incur much greater cost than an independent committee? Is there a disadvantage? Why not just do the COI, if there is nothing to hide?

2) If a cluster of deaths do not meet the threshold for implementing a COI, then this raises the question: What would be a serious enough incident? Accidental black hole? Heat death of universe?

3) Why is MOH protesting so defensively? Not once, but twice (once against Rachel Chang, and once against WP)?

It would have been so simple, reasonable and appropriate to say that a COI is not necessary at the moment. because a COI can still be convened after the initial investigations by the police and review committee. The call is premature and the juz WP wayang, trying to show that its not the Worthless Party.

Instead, the MoH’s reply to the WP to produce evidence came across as dismissive, defensive, aggressive and arrogant. This should not be the way if the MoH is not trying to hide anything.

The WP says rightly that it’s “inappropriate” to call for the WP to present evidence before the COI) into a Hepatitis C cluster at the Singapore General Hospital can be convened.

Finally, I note the health minister wasn’t good in MoM too. Maybe he’s scare to get moved on out like Lui, Paymond Lim? Juz wondering.


*The Workers’ Party welcomes the broadening of the remit of the independent review committee to include review of MOH’s procedures and actions.Drawing the right lessons from the outbreak of the Hepatitis C virus infections at the renal ward of the Singapore General Hospital (SGH) is critical for Singapore. It is tragic that four individuals may have lost their lives as a result of these infections in one of our leading healthcare institutions, and one more person may have died for reasons possibly related to the infections.

The outbreak and the government’s response to it have exposed potential gaps in our public health protection protocols. Aside from the risk to human life, the matter has considerable implications for Singapore’s status as an international business and tourism hub.

The work of the review committee is critical not just to rectify any lapses to prevent future recurrences, but to maintain and bolster public confidence in our healthcare system and review processes. To this end, not only must the review be rigorous, transparent, independent and fair in terms of its outcomes. It must also be seen to be so.

With these ends in mind, we call on the government to pursue the following actions in respect of the committee’s work.

  1. The government should explicitly task the committee to investigate the reasons for the extended delays between:
  1. The discovery of the cluster in April/May and the notification of MOH in late August.
  2. 3 September when MOH’s Director of Medical Services knew of the existence of the cluster of 22 infections, and 18 September when the Minister for Health was informed of the cluster.
  1. The terms of reference of the committee do not explicitly state that the committee is required to arrive at conclusions and recommendations about the timeliness of public alerts and preventive or containment measures. Given that the public was only informed about the cluster in October when the probable existence of this cluster was discovered in April/May, we repeat our call for the committee to review:
  1. If existing protocols about timeliness of public alerts and containment measures were adhered to in this instance; if so, how can these protocols be improved upon as they have been shown to be lacking; if protocols were not adhered to, why not; and what measures are recommended to strengthen adherence towards zero fault tolerance on such matters of life and death.
  2. If protocols do not exist, to recommend protocols that should be adhered to in future in respect of the maximum time frame for ascertainment of an infection cluster, for MOH notification, public notification and commencement of containment measures.

The Workers’ Party regrets the degree of delay between the discovery of a probable cluster of infections in April/May and the initiation of public notification and screening in October. We note that the Press Secretary to the Minister for Health stated, in a letter to The Straits Times Forum published on 20 October 2015:

“Medical professionals and public officers in MOH and SGH sought to perform their duties professionally and objectively. They acted in the interest of patient safety and to minimise risks to patients. Political calculations played no role in their consideration of the proper course of action. To suggest otherwise impugns the professional integrity of these public servants, who are unable to reply to defend themselves.”

We hold that a responsible and transparent government should explain in detail how the delays in public notification and screening from April/May to October represent actions that were taken in the best interests of patient safety and risk minimisation to patients.

Calls on the government to explain the delays in detail should not be met by calls to provide evidence of any inappropriate motivation.

Now that the review committee’s remit has been broadened to cover MOH’s workflow, we also call on the government to take action in regards to the committee’s composition and procedures in the following two regards:

  1. In the case of the Committee of Inquiry into the 15 and 17 Dec 2011 MRT breakdowns and the 8 Dec 2013 Little India Riots, the deliberations of the committee were made public so as to strengthen public confidence in the security and public transport systems respectively. In this case, we recommend that the deliberations of the committee likewise be made public. The Hepatitis C outbreak is at least as grave an incident as the MRT breakdowns and Little India riot, with serious implications for the public confidence of Singaporeans and foreign stake-holders in our vital national institutions. So as to facilitate this and in line with the norms established by the COIs relating to the MRT breakdowns and the Little India riots, we recommend that the current review committee be reconstituted as a Committee of Inquiry (COI) under the Inquiries Act.
  1. We note that the review committee is composed of currently serving clinicians in public healthcare institutions. Now that the committee’s remit has been broadened to include a review of MOH’s workflow, these individuals are effectively being asked to critique the actions of senior civil servants who oversee and administer government policy that affects their work as clinicians on a day-to-day basis. This would place members of the review committee in an awkward position. We suggest the inclusion of retired clinicians and healthcare administrators in the committee and the appointment of a retired healthcare administrator or clinician as co-chair. We further suggest that one of the committee’s members be a person qualified to be a Judge of the High Court, as required by the Inquiries Act should the committee be reconstituted as a COI. This would strengthen the ability of the committee to conduct a truly rigorous and, where necessary, critical review.

In this grave matter, the review committee bears a huge responsibility. We offer these suggestions so as to strengthen the review committee’s ability to do its job well and to be seen to be doing so.


25 October 2015

++In response to media queries on the Workers’ Party’s statement today, the following can be attributed to the Press Secretary to the Minister for Health:

The Workers’ Party (WP) has called for a Committee of Inquiry (COI) into the cluster of Hepatitis C cases at the Singapore General Hospital (SGH).

An Independent Review Committee has been appointed to review the cause of the incident and surrounding circumstances. To facilitate its work, the Review Committee has engaged additional resource persons, including international advisers, to ensure that it has access to all the necessary expertise to do its review thoroughly.

The Committee’s findings and recommendations will be made public. A Police report has also been filed and the Police are conducting investigations.

The WP statement is careful not to make any suggestion that SGH or MOH officers acted with improper motives. Yet it has asked for a COI ahead of the Committee’s report and the conclusion of Police investigations. If the WP believes that there are questions that the Committee cannot answer, or that any officer acted with improper motives, it should state so directly. The Government will convene a COI provided the WP is prepared to lead evidence before the COI, to substantiate whatever allegations it might have.

25 OCTOBER 2015

Taiwanese offer prizes not fines in dengue fight

In Uncategorized on 02/11/2014 at 4:25 am

People in a southern Taiwanese city have been offered prizes for catching mosquitoes.

The contest, announced by the Kaohsiung city health department, is aimed at tackling an outbreak of the mosquito-borne dengue fever in the region. Residents are being asked to catch as many mosquitoes as they can, dead or alive. Whoever captures – or squashes – the greatest number will be rewarded with NT$3,000 (US$100; £62), the health department says. Runners-up will be given free insect repellent and mosquito nets.

People will have to either trap the insects securely or hold on to their remains, because they’ll need to be presented to officials for counting. “Instead of fining people who fail to remove standing water and other breeding sites around their homes, we think this program could raise greater community participation,” Ho Hui-ping of the city’s health department tells the Focus Taiwan website.

Did our scholar minister and civil servants think of this?

Maybe they tot about it but that concluded S’poreans think US$100 is “peanuts”? Juz like our ministers seem to think their salaries are “peanuts”?

Medishield: Totful tots on loss ratio to determine premiums

In Financial competency on 14/07/2014 at 5:26 am

With regards to the use of  incurred loss ratio to determine the level of premiums, I don’t like it for a few reasons:

  • A lot of premiums is collected upfront and Medishield ends up having a lot of money to invest, which might not be its core expertise.
  • It is not easy to determine future liabilities and brings another uncertainty to the calculation of the loss ratio.
  • With Medishield Life going to be a compulsory scheme, there is even less of a need to collect too much surplus as it is possible to adjust the premiums accordingly whenever overall claims go on a sustained uptrend. As a nationwide scheme, the pool is also huge and total claims will be less volatile and predictable.
  • Private health insurance that has a smaller pool will have claims that are more volatile and cannot easily raise their premiums without the risk of their customers leaving and making their pool even smaller.

From an honest financial planner. Feel safe to buy second-hand car from him. Smart guy too. Given that he has a masters in engr from NUS, I once asked him why was he wasting his time selling insurance. Never got a gd reply.

Check out his other articles explaining Medishield. Under insurance, healthcare.

No worries abt one-yr wait to see renal specialist

In Financial competency, Humour on 27/09/2013 at 5:00 am

I refer to and to

They are all very angry people because Ms Tay’s hubby has to wait for a year before he can see a kidney specialist.

I know someone who recently was told that he had to go to see a kidney specialist. He was then told by the girl responsible for making an appt that the waiting period was one yr if not longer. He juz shrugged his shoulders.

He was pretty relaxed abt waiting because

— He knew that there is a priority procedure for “siong’ cases. He had benefited from the priority list several yrs ago when a routine check had the doctor concerned about his eyes. He got an appt to see a specialist within weeks. I have had a similar experience.

— He also knew that the polyclinic doctors were monitoring the situation, via tests every time he renewed his medication. The doctor had told him that the dosage of one pill could be increased if necessary.

— The doctor had given him a copy of the results of his test. He was thinking of consulting a private-sector GP that he trusted to ask him what the results meant: is he in clear and imminent danger of dying, as Ms Tay seems to fear for her hubby? He could have also asked one of our mutual doctor friends, but felt piah seh.

— According to my friend, a doctor once told told him that polyclinic doctors knowing the length of the queue do put marginal cases on the waiting list juz to be kia-su: anticipative medicine that should be commended.

— If nec, he would consult a private sector specialist and then return to polyclinic with the results. The worse case would be if he got warded immediately as a private patient because things were that bad.

Be very clear, neither of us are defending the staus quo: one yr’s wait is not right, if one cannot afford to go “private’*. Especially, as there is the Toto element in the system. It is sometimes (very rarely to be fair) possible that if the polyclinic calls to make an appointment, it will be told that someone has juz cancelled and that there is a slot available say in two months. The polyclinic may grab the spot for the patient, and tell the patient that “die, die” got to go.  Conscientious staff do this even though there are consequences for the staff if the patient is daft not to take the lucky opportunity. I have heard that it does happen: daft patients who refuse to take the slot because got “other appointment” like going to beautician, or got golf game.

The system should be changed so that all such cancellations are offered to the next person in the queue. Only fair. Of course, this assumes that the IT system can cope with such changes. It may not be possible with legacy systems.

But, we are saying that she (and presumably hubby) are being too KS, and emotional. They also do not seem to trust the doctors, or the system. We don’t assume that the doctors or the system are out to fix us.

As to the comments of Redbean that a first world system shouldn’t have anyone waiting for one yr, juz google up the topic of waiting lists in the UK’s NHS system, one of the world’s finest. The issue is simple. In healthcare ,the demand is endless, resources are finite. There are two ways to handle the problem, rationing by

— wealth, the American way.

— queuing, the NHS way.

I wish Redbean, and all those TRE readers commenting on Ms Tay’s letter read what Jeremy Lim has to say, before they comment adversely on the healthcare system here. He also wrote shumething similar in ST

Read both articles. Jeremy Lim has his heart in the right place (unlike a certain sneering minister who was a doctor), but knows the practical problems of providing “affordable” healthcare.

Let’s be informed on the topic before opening our mouths. Don’t talk cock on this v. v. impt issue. Don’t use it to express cliched anti-govt or PAP cliches. Even the WP doesn’t.

*We are assuming Ms Tay’s hubbie has financial concerns but can afford to visit a private GP to ask what the test results mean. We are also assuming that they can know a gd GP, by reputation, at least. I hope they are not like a very rich neighbour who uses the public healthcare system but who is always complaining that she never sees the same specialist or GP again: always new one she complains.

It is acceptable if one is cheap-skate, or searching for “value’ person. My friend was an arbitrageur when he worked in the stockbroking industry. He believes that there are always free lunches but one mustn’t be choosy or picky. But he warns to be careful to avoid getting food poisoning. One bad case of food poisoning can wipe out the savings made, unless one goes to a polyclinic for treatment.

Cost effective ways of keeping us healthy?

In Infrastructure, Political economy on 17/10/2012 at 5:36 am

Yesterday, I read that the government is planning to do more to help the depressed and I remembered that I chanced across this (see below) response to an Economist blog piece on escalating medical costs in the developed world. It suggests (among other suggestions) adding various soluble drugs to the water Americans drink as a way of keeping healthcare costs down: one of the drugs is Prozac which is a drug that helps control mild clinical depression. Other drugs suggested are statins and aspirin.

Now that VivianB (a MD) is water minister, he may want to help out the Health minister. These measures seem to be in line with S’pore’s policy of spending as little as possible on health (around 4% of GDP) without upsetting economic efficiency or upsetting the masses compared say to Switzerland (around 8%).  And we already drink recycled water. LOL.

Seriously I hope the SDP looks into these suggestions. SDP has a very gd team of doctors helping out. (BTW what do these MDs have to say about:

this plug for govt health policy;

the latent flaw in any public health insurance scheme; or

innovative ways of helping the elderly in ways that don’t cost too much money?)

(Note writer below is talking of the US, where fluoride is already added to the water they drink. Always wondered why this doesn’t happen here.)

America comes up short in international comparisons of health statistics principally because life expectancy lags despite the highest spending for healthcare. For less than one dollar per capita , I propose Ten Inexpensive Health Interventions WILL Improve Health Outcomes. These will lengthen life expectancy, improve health, increase happiness and decrease dysfunctional behaviors.

We already fluoridate the water to prevent dental caries. And chlorinate to reduce bacteria. We can use the water supply as a medication distribution network by introducing very tiny or trace amounts of medicines that have been known to reduce major diseases.

1.) Simple cheap ASPIRIN dramatically cuts rates of Strokes, Heart Disease and now recently proven in a longitudinal study, reduces Cancer death rates by 20%! Put ASA in the water supply–if would be cheaper than fluoride.

2.) Put STATIN drugs in the water supply. Heart disease and stokes are declining for the first time in history. And it is despite the epidemics in Diabetes and Obesity. It is due to widespread use of effective anticholesterol drugs known as ‘statins.’ ie. Lipitor. High cholesterol is endemic and contributes to strokes and heart attacks. Just about everyone benefits from lower cholesterol.

3.) Water Born Oral VACCINES. Up to 30% of parents do NOT believe in the value of vaccinations and many act on this belief. Utilize water borne vaccinations in the water supply, such as the oral polio Sabin Vaccine. Put Folate in H20 to prevent neural tube defects in fetuses.

4.) PROZAC to decrease Dysfunctional Behaviors and improve Mental Health. Far more common than crime is non-criminal personal dysfunctions. Up to 40% of Americans will experience a diagnosable mental illness in their lifetime including Depression, Alcohol abuse, illicit Drug abuse, Anxiety disorder, PTSD, Obsession-Compulsion, Eating disorders. Half of these will remain undiagnosed. And love ones suffer by enduring the mental ill relative like an affliction. Virtually all these maladies would benefit from Prozac type drugs which increase brain serotonin neurotransmitter. It is a vital tool in psychiatry: ‘Vitamin P’. Put Prozac in the water supply and we will be less sad, less depressed and less dysfunctional. It will shrink dysfunctional behaviors, criminal behaviors, afflictions and addictions. It would save BILLIONS in the Criminal Justice System. Lead to more productive fulfilled citizens who are happier. Less alcohol and drug addictions. Less DUI, trauma and killing sprees.

5.) Perhaps an effective future drug to treat or prevent Diabetes or Obesity–put it in the water. We have a new Epidemic of Obesity never before seen in the history of civilization. All interventions have been stymied to reverse the epidemic. We have to be creative about how to address this problem. The water supply is a simple and effective vector that treats the entire population. Observe the effectiveness of fluoridation on cavities for pennies per capita per year.

6.) Ban Tobacco Products, the leading Preventable cause cancer deaths, heart attacks and strokes. It would cost nothing in health care but would literally overnight vault the US life expectancy over the #1. Japan.

7.) Restrict television broadcasts to 2 hours a night of quality programming from 8 pm to 10 pm. We get 24 hours of 1000 channels–98% is garbage programming. It would force Americans to find other more healthy forms of recreation like walking, exercising, reading and even talking with each other. We undersleep and spend 4-6 hours of waking hours watching TV.

8.) Make Supermarkets reflect a Vegetarian Diet. 80% of floor space for Produce. 10% for dairy. 10% for the meat department. Vegetarians live longer and are more active. We have to make it easier and more desirable to enjoy vegetables Likewise encourage walking, exercise, and activity.

9.) Tax Alcohol extremely regressively to the point that consumers have to hurt to make a purchase. They will value that little sip of brandy or Chardonnay even more. Make bottles much smaller at around 100 ml. Like a Coca Cola at the turn of the century: medical tonic amounts. Yes people can drink, but moderation(less than two drinks) is best.

10.) Milk-Based Nutrition/ Beverages. To increase calcium in young persons, make all flavored beverages and hydration drinks MILK BASED. A milk based Coca Cola. We will see taller, more active, healthier citizens. Perhaps the best way to combat osteoporosis in the elderly is fortifying bones in teen age girls. And using high impact sports like simple rope jumping. This will make a difference in the wide spread osteoporosis of the elderly. Your skeleton will thank you decades later.

This is a radically different way of thinking about Public Health, Medicine and Wellness.

Desperate Times Call For Desperate Measures.

Make Public Health medication an automatic feature by incorporating it into normal plumbing.

Let people OPT-OUT by buying their own water and we will have 95% participation.

We now have an OPT-IN system for medicine that is not working.

Healthcare delivery is a complex problem requiring smart solutions, but sometimes solutions can be as simple as fluoridating water. We need a Fluoridation System for the 21st Century.


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